« on: August 27, 2019, 03:22:10 pm »
From NEJM Journal Watch (August 27, 2019):
Predicting Disability Using Baseline and Follow-Up MRI in Multiple SclerosisRobert T. Naismith, MD reviewing Brownlee WJ et al. Brain 2019 Aug 1Gadolinium and spinal cord lesions were consistently predictive.Several studies have questioned the long-term significance of gadolinium-enhancing (GdE) and spinal cord (SC) lesions in early MS (NEJM JW Neurol Jun 2018 and Mult Scler 2018; 24:481). To further examine the associations, investigators analyzed 164 patients with clinically isolated syndrome.
Mean follow-up was 15 years. MS developed in 119 (73%): relapsing-remitting (RR) in 94 and secondary-progressive (SP) in 25. Development of SPMS was associated with ≥1 spinal cord lesion at baseline, ≥2 GdE lesions at baseline or follow-up at year 3, increasing supratentorial T2 lesions at years 1 and 3, and new infratentorial lesions at years 1 and 3. Logistic modeling confirmed that ≥2 baseline enhancing lesions and ≥1 baseline spinal cord lesions were associated with higher odds of SPMS at 15 years. At years 1 and 3, ≥1 new spinal cord lesion and ≥1 new infratentorial lesion were also predictive of SPMS.
Linear models identified that ≥2 baseline GdE lesions and ≥1 baseline spinal cord and infratentorial lesions were associated with worse expanded disability status scale (EDSS) scores and 25-foot walk times at 15 years, as were new spinal cord and infratentorial lesions at 1- and 3-year follow-up. Worse nine-hole peg test times at 15 years were associated with ≥1 baseline GdE lesions. Worse symbol digit modality test scores (measuring cognition) at 15 years were associated with ≥1 GdE lesions at baseline and ≥1 new supratentorial lesions at 1-year follow-up.COMMENTAlthough MRI findings do not always correlate with current and short-term disability in patients with MS, they appear to hold value for predicting long-term disability. GdE, spinal cord, and infratentorial lesions and new lesions at early imaging follow-up appear to be associated with worse outcomes by several measures. The limitation is that this is a small, select cohort that has been reported on multiple times. Nonetheless, this study highlights the importance of long-term follow-up for understanding the latency between MS lesions and clinical outcomes.
« Last Edit: August 27, 2019, 03:25:33 pm by agate »
MS Speaks--online for 17 years
SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.